The region of the hernia repair is commonly affected by hardness, swelling and bruising which are related to the clotted blood and fluid under the wound, the stitches pulling the wound together and finally by scar tissue formation. These difficulties all settle over time as the area heals. The genitals can be affected by bruising and then they can become black and blue. This is because downwards is the obvious direction for any bleeding to track after the hernia repair.
Bruising can be very widespread at times and sometimes a blood collection called a haematoma can present as a bulge under the skin or close to the repair, caused by small blood vessel bleeding. A haematoma may gradually resolve over time but at times may need surgical exploration and evacuation. Swelling around the testicle can remain for a long period if bleeding tracks into the scrotum.
During the operation a small nerve which travels across the incision line may be cut through, causing a minor area of numb feeling at the inner end of the incision. To do the operation well this nerve has to be cut but because the numb area gets smaller with time and is hidden under the pubic hair it does not normally cause any problems. A chronic pain problem over the area of the repair can develop in one in twenty patients and can be a significant problem. Nerve stretch as the operation is being done or the nerve becoming tethered as the healing proceeds are possible reasons for this pain. A pain killer can be injected into the painful area to reduce the pain but in some cases the surgeon will need to re-explore the area to find the trapped nerve and release it.
During the operation all the structures close to the hernia, including the tube carrying sperms, the vein and the artery, are all at risk of damage. In recurrent hernia surgery the risk to these structures is greater. Damage to the artery can result in ischaemic damage to the testicle and it may then shrivel and need to be surgically removed. Damage to the tube carrying sperms means that the ability to be fertile will depend on sperm from the remaining testicle which is usually plenty. In older patients the removal of the testicle can be advised before repairing a recurrent hernia to get the best outcome.
Wound infection is uncommon but is a risk and if the wound reddens then a prescription for antibiotics will be necessary. The wound may need to be surgically explored to release infection if pus develops and starts oozing from the wound. The hernia is more likely to return with an infection present. A further operation may be needed to remove infected mesh and then the hernia will be repaired once more at a later time. After hernia repair deep vein thrombosis (DVT) is rare but important, with doctors taking special precautions should the patient have a raised risk of clotting. To reduce the risk of thrombosis it is useful to start moving the legs and feet and getting walking about again.
The chances of a hernia happening again are less than once in twenty cases after the first repair of a hernia. To have a general anaesthetic involves some risk and this is greater if the patient is suffering from a longstanding medical illness or disease. Short term side effects with the frequency of one in ten to a hundred are blurred vision, pain over the site of injection, bruising and sickness. These are easily managed and do not persist for long.
Less common complications with a frequency 1 in 100 to 10,000 cover pains in the muscles, damage to the lips, teeth or tongue, headaches, temporary problems with speaking, sore throat and short term breathing difficulties. Serious and very rare complications with a frequency of less than 1 in 10,000 cover kidney and liver failure, long term nerve or blood vessel damage, damage to the lungs, eye injury, voice box damage, brain damage, severe allergy reactions and death. The rarity of these complications means that the frequency depends on co-existing medical problems.
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